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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 6901 Date: Owner: leig Buildet? Address LOITION OFffl ING No. Street t Lot Block ddition or Sub -Division Corner Lot Inside Lot _ _ �� Setback 31� tSideyard _ 4, Sewer Elevation _Z 7—Z Elevation DESCRIPTION OF BUILDING T Used : Front Depth Height Z 1 Sq. Ft. Cu. Ft. 0 Fro t DepthHeight 146o q. Ft. � Cu. Ft. fftrd Type of nstruction Est. Cost __o`ie Completed _ In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in compliance with a'A provisions of ordinances of the city of Fridley. A,&a In consideration of the payment of a fee of $X I?`�, permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings owithin the rdinances city limits andthispermit may be revoked at any time upon violation any of the provisions of said Building Inspector NOTICE: Ob permit don not cover the eonstwedon, Imhllatton for wWng, phanbing, gn heafte, saver or water. Be euro to see the Bullding kgmtor for separate pwaft for #boss Nems. City of Fridley _ Application for Plumbing and Gas Fitting Permit "- DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: 3 Number Fixtures ....... F $� , U in 3 c New Fixture Old Opening .............. LL a <Z V Catch Basin ............................ x 3.25 $ 0 Z O � R f N WATER HTR. GAS ELEC. Base r 1st 2nd 3rd _ 4th • Future Connection Openings s New Fixture, Old Openings I Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... 6 x $1.50 $� , U Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ a New Ground Run Old Bldg . ............ x 3.25 $ r GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL — x $1.50 $� — x .50 $ — x 2.00 $ Dept. of Bldgs. Phone 8U 4 City of Fridley: The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this afp ication are true ,and cop4act. Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—ew. uilding Permit No Permit No. Signe By Business Phone No J Rouo (-P i FINAL Description ........................................ TOTAL FEE r�� ax 2M �22 Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM, AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ C) each add. 80,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM NO RATE 1st 3 Fixtures ...................... Furnace Shell & Lines—to 400 sq. ft. EDR Steam .. 8.00 $ } Furnace Shell & Line—to 640 sq. ft. EDR, Hot Water ... 8.00 $ i Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour . ..................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ gr. m0 — GAS FITTING FEES: NO RATE 1st 3 Fixtures ...................... x $1.50 >>T��OT�qALL $ Additional Fixtures ............... x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone _SU 4-7470 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Kind of Used a. Fridlev. Minn_ '/ — d _ 19 �i To be completed about 3e Estimated Cost, $ Ol Ne wilding Permit No. G Permit No. o� DESCRIPTION OF WORK HEATING or POWER PLANTS- Steam, Hot Water, Warm Air—No OW Trade Name-,=-�is - Size No-'�=�/- Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load �Z Rind of Fuel BURNER — Trade Name Size No. Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signe •' By ���T META 42 4M Busines M POLIS 3 2, s MINNESOTA n� az # s HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Jlnt.Wall I Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19_ FI.I jV. _ Room I Length / 02' Width JA / Height v Room I Length J 6;' Windows and Doors—Crackage and Area Coef. Btu Width Height No. of Lineal ft. Area No. of pane of pane lights og crack sq. ft. Jai, Area sq. ft. / !W Infiltration Coef. Btu Infiltration -20 Glass e Exp. wall Net exp. wall ,•d Coef. Btu Int. wall Coef. Btu Ceiling / Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. .A. Leader area / FI.I i Room Length /-J / Width //4Ieight Windows and Doors—Crackage and Area Coef. Btu Width Height No. of LI eal ft. Area No. of Dane ofpanellffoot�x o crack aq. ft. �" o`- Area sq. ft. / !W Infiltration Coef.1 Btu Infiltration Q v Glass e Exp. wall Coef. Btu Net exp, wall Int. wall Coef. Btu Ceiling / Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 7 Fl.i 775i. 71 T.Room ILength )' Width /q/Heiaht k / Win ows and Doors—Crackage and Area Coef. Btu Width Height No. of pane ofpane No. of Lineal ft. lights of crack Area sq. ft. / !W Infiltration y Glass Exp. wall Net exp. wan Int. wall Q v Ceiling , e Floor Coef. Btu Infiltration Coef. Btu Infiltration ' Glass Glass Exp. wall Net exp. wan Int. wall Exp. wall -• Ceiling Net exp. wan Floor Int. wan 1 btal titu. Required sq. ft. E.D.R. or sq. ins. W.A. leader area Windows and Doors—Crackage and Area Coef. Btu Width HeightNo. of Lineal ft. Area No. of pane of pane lights ofcrack sq. ft. oma/ o! / / !W Infiltration y Glass Exp. wall Net exp. wan Int. wall Q v Ceiling , e Floor Coef. Btu Total Btu. I v/ Required sq. ft. E.D.R. or sq. ins. W.A. Leader area % FI.I Room I Length /<--Width // 'Height ` Windows and Doors—Crackage and Area Width Height No. of Lineal ft. No. of pane of pane lights of crack Area sq.. ft. / -2— -a,6 / !W Coef. Btu Infiltration Glass Exp. wan Net exp. wall Coef. Btu Infiltration f}; Ceiling ' Glass % •�} Exp. wall Net exp. wan Int. wan Ceiling G Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area , / Fl.l .ength >-,00 r Width I / Heights / Windows and aoors--Xrackage and Area Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack eq. it Coef. Btu Infiltration Glass Exp. wan Net exp. wall o Int. wall Ceiling D Floor 1 otal Btu. Required sq. ft. E.D.R. or sa. ins. W.A. Leader area 53-84-S-915.51 City of Fridley Applicaffm for Mmbbig and Gm Dept. of Bldge. Phos 50-345D DESCRIPTION OF WORE[ 14�5 N. E. Onondaga Street Number, Kind and LocaBiou of TUttufts ' Base • • wATP VM. City of Fridley: .3 I j o p eAs ILM The undersigned hereby makes application for a permit for the work here!, specified, agreeing to do an work in strict accordance with the City Ordinance and ruling of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct s 1 Gr 11 Fridley, Miww 4-18—?3 .19. Owner Raymond Buechele Kind of Building Frame Sewer with 0 Used as Res. To be completed about 4-25--73 PARTIAL RATE SCHEDULE PLUMBING FIXTURE EXTES: NO. BATE TOTAL Number Fixtures ................ x $2..60 $ Future Fixture Opening ........... x $1.50 $ New Fixture Olaf Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water heater 'Up to 09,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. a $200 $ GAS FITTING FEES. NO. RATE TOTAL lat 3 Fixtures ..... • • —z$&00 $ wdditional 1113thim............... x $ .7 $ Gas Range to 195.000 BTU .. ,......... x $5.00 $ State Surcharge $ .50 REPAIRS & ALTERATFONb Refer to Cando Description..............Install Grill..........; 5.00 TOTAL lM $ 5.50 OW "Aa :q:UT03r9e $.5o Estimated Cost, $ 10.00 Old- rXBuilding l�ermit No. Permit No. Signed By IPJ Business Phune No ROUGH � Os, 'aur " . e dztr ago V 1 , ®B mdra %nz'613 ama Air -Ahilrig yra®eve PARTIAL RATE SCHEDULE GRAVITY WARM Alai: RATE '1°O`I'AI. Furnace Shell & Duct Work 410.00 $ Replacement of Furnace 600 Repairs, & Alterations—up to $300.00 6.00 R Repairs & Alterations each add. $500.00 300 $ NSECH. WARM AM Furnace Shell & Duct Work to 120,000 BTU each add. 60,000 BTU . .. ...... Replacement of Furnace Repairs & Alterations—up to $300.00 Repairs & Alterations each add. $300.00 STEAM or HOT WATER SY8TEN ..$10.00 $ 3.W i 6.00 8 &00 3.00 $ Furnace Shell 3s, Lines—to 400 sq. ft. F.DR Steam $10.00 $ Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $. Each add 200 sq. ft. EDR Steam xon $ Each add. 320 sq. ft. EDR Not Water 3.00 $__ OIL BURBLER—to 3 gaL per hour 6,00 $. over 3 gal. per hour ---See Fee Schedule GAS BURNER Cup to 19,000 BTU) 8 $ aver 1999,000 BTU So* Foo Modulo GAS FITTING MEE8: NO RATE TOTAL Ist 3 Fixtures A$ 200 E Additional Fixtures x .78 $_—. Gas Range W INAW 4 5.00 $ AIR S ���all li. State Surcharge 500 x' (emwaL Saa Fra TIZTA.d3TMG BTSTM ALTZRATIOns & FUMAM TOTAL. 7= $ /� Flail$. 5-.2,57-74 fit. of 161dgm. phonm SM -3m r L City of Fridley: The undersigned hereby makes application for a permit for the work here&. specified. agreeing to do all work in strict accordance with the City Ordinancef and ruling of the Department of Buildings, and hereby declares that all the facts, and repres?ntatauns stated in this application are true and correct. Owner Kind of Used as Tohe0 mated Cost:, $ q®®• ®® New. Building Permit No. _—_ Permit No. HEATING or POWER PIANTS—Steam Hot WaterR Warm Air—No Trade Name g1= No Capacity—___ _ S1. P_ E.D.R BTU— Total TU Total Connected Load Mnd of Feet BURNER — Tri Namrte Size Flo Capacity Sq. Fi. ED BTU 1 t�as+aeat�omatal , 3 G$ lie _51182 WEST BROADWAY iWJN. 55429 535-2M PARTIAL RATE SCHEDULE PMMING. FIXTURE RATES; NO. RATE 1.W:.1Sr Futures •• ��� K $3,00 N-.ure !'!xture Opaning _ >1 $2.00 New Fixture, OLd'Oponing x $2,00 Nater x .�. ."c x $5.600 h x n Nater Sof caner _. m .;; A u �' F. $5.00 Elacrrlc Wstor Heater - IlaatoC 55,00 .CAS FITTING FEES; �J w x c i.Jd1cicA&1 rixturea _ter x 1 •C j .� x u RFP�IRS L ' c o 'N ''lc H o a b g 0 u' a a'�s A w ti x ne lec . (R) - Ntura Comacdon Opening Connected with Suwor (6) - 11aw Figimra, Old Opening Nater PARTIAL RATE SCHEDULE PMMING. FIXTURE RATES; NO. RATE 1.W:.1Sr Futures •• ��� K $3,00 N-.ure !'!xture Opaning _ >1 $2.00 New Fixture, OLd'Oponing x $2,00 Cstch 9iein • x $5,00 t.wstor Nosur - to 99,000 bTV,-`' x $5.600 100;C00 ITV to 199,000 BTU x $10,00 Nater Sof caner _. x 17,00 ' Neu Ground' M% Old Suildirq .--..-� x $5.00 Elacrrlc Wstor Heater - x 55,00 .CAS FITTING FEES; 12t 2 fixtures x $3.00 i.Jd1cicA&1 rixturea _ter x 51,00 C.s s Rsng a to 199,000 BTU x W. 00 RFP�IRS L ' - 4 rl TITRATIONS rir,t sloo.00 each aCd. $100.00 or fraction State Succharge TOTAL FCC TOTAL ob draw 1h?5 Mond�;,go StPP.P.'): Department of Buildings ' City of Fridley 1 Ta X. N571-3450 ` Via undersigned hereby seeker application fora permit for the w epoaified ngruoLng•to do all work in etcict accordance with the C and rulings oC the Department of Buildings, and hereby daclarel t the facto and roprgountatLons statod in this application aro true ' Fridley, M.%, 2�7-713 OWNER RAYMOND BUECHELE KIND OP BUILDING frame USED AS res_ TO BE COMPLETED "OUT 2-]1- '78__ ESTIMATED COST 20.00 OLD - NEN 11UILDIIIG PERMIT NO, NEfY1IT 110. Co=z mp ' tAINNEGAW EGASCO Signed By' Tel, No, ROUGII INSP. ' DACe , FItJ1�L INSP. _ ;Z. Y - S Da t o ' APPROM FOR PERMIT $5,00 5 12.00 $ ---•- S S0 8.o0 MIIIIMUM 1'EB FOR MIY PLUMRINO PERMIT 19 37.50 IT HOUSE HEATING TEST RECORD ADDRESS 1425 13nondago ►nt s APT. FLOOR BasBLQITY SUBURB Fridley OCCUPANT Raymond Buechele OWNER HEAT LOSS DATE HTG. INST. SOLD BY Minnegasc o, INSTALLED BY N Qe oe'G Electrical Work By Gas Line By 41 C O TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHef fireplace CONVERSION CONTROLS THERMOST T Hea Plug Vent Size Valve �® KIND OF LINER SIZE NONE Limit Draft Hood Regularor Limit Setting Filters Size Number Fan Setting `- Chimney Location Inside Pilot Type P f` - Chimney Construction Pilot Make Outside Pilot ModelSmoke Bomb Wiring Pilot Timing � Draft Test Tog- L.W. Cut Off Door Pressure Lightin Inst. Pressure _ Percent CO2 Input CFN Percent 02 Stack Temp. Percent CO Form 235 Date Tested r C Company Testing ! ra Name of Tester GAS DESIGN MAKE ``iAg1Ar MAKE OF BURNER_ Model SFS *+F+2 Model Serial H 13 7 O Max. BTU Rating — INPUT 25M MAKE OF FURNACE Model CONVERSION CONTROLS THERMOST T Hea Plug Vent Size Valve �® KIND OF LINER SIZE NONE Limit Draft Hood Regularor Limit Setting Filters Size Number Fan Setting `- Chimney Location Inside Pilot Type P f` - Chimney Construction Pilot Make Outside Pilot ModelSmoke Bomb Wiring Pilot Timing � Draft Test Tog- L.W. Cut Off Door Pressure Lightin Inst. Pressure _ Percent CO2 Input CFN Percent 02 Stack Temp. Percent CO Form 235 Date Tested r C Company Testing ! ra Name of Tester SUBJECT City of Fridley 29325 AT THE TOP OF THE TWINS BUILDING PERMIT ` COMMUNITY DEVELOPMENT DIV. L ------ r PROTECTIVE INSPECTION SEC. � I ✓ ---Il � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910415 4/28/99 JOB ADDRESS 1425 Onondaga Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 Gunderson Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Hung Tran 1425 Onondaga Street NE 792-0756 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (20 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ $ 86 WITHIWHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,714 • DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. $56.75 Fire SC $1.71 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $59.32 Tu OiCON'RACTOR 1ZE0AGENi (DATED WHEN PROPER - VAS YOUR / %PERMIT ^40 SiGAFATURE OF OWNER,6 OWNER BUILDER, !DATE, 81JOG ,NSP [ GATE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: c� Legal Description: Z -()T 10 P L C Owner Name & Address: -414 N Cr Tel: # 79a O `% JG Contractor: 0 W N FA MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: P, F �© 47 4-(15kk5P-. , -M ! L ' --f-TFok Dpf:z- I ( -,2 0 Construction Type: 1,j RA0F Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -29A q::\ APPLICANT: ] Tel. # 7 O 7 S—C=, Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] $ 3.2 . Building Inspections 7.632572-3604 DATE L I SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL Permit No.: RESIDENTIAL APPLICATION Received By: CITY OF FRIDLEY Date Rec'd: Q YOUR E-MAIL ❑CONTRACTOR NAME: v. N - - r �. - — _ ADDRESS: I G A 5- ON 466 '+ S � CITY STATE 1�I�ZIP��L PHONE: 7 12 - y SY COMPANY NAME: CONTACT PERSON: STATE LICENSE # EXP DATE CITY STATE ZIP ADDRESS: PHONE SINGLE FAMILY ❑ TWO FAMILY ❑ NEW *PLACEMENT DETAILED DESCRIPTION OF WORK FAX ❑ TOWNHOUSE ❑ ALTERATION/REMODEL MS 1613.665 the fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the PER permit of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) improvement, installation or replacement Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor—x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERENOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) MODEL: MFG: _ SIZEIBTU Equipment Installed MFG: MODEL: - SIZEIBTU MFG: MODEL: (GAS) $15.00 SIZEIBTU GAS RANGE/OVEN $10.00 ✓A/C $25.00_FIREPLACE AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 GAS UNIT HTR $10.00 _ FURNACE $35.00 ILER $35.00 GAS DRYER $10.00 _BOCHRANEY POOL HEATER $35.00 LINER $10.00 DUCT WORK 510.00 _GAS PIPING $10.00 VENTILATOR $15.00 v"t=Y:: .' : ...rl�,SHi'lLa'!?Tj:pun. !.w•c+as.. us7'�Sac>;:'et'.: e .x:-...o:.rz _ :,:...,». „._ _. _.. Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.00 —� x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ s .w State Surcharge = $ 50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I herebyapply for a building `ermit and I acknowledge that the information above is complete and accurate; that the work will be in PPY gP conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whiomquires review and approval of plans. ,, ,, /� SIGNATURE OF APPLICANT PRINT NAME R' tf N� TR -6 /t—/DA`TE Z � �'U O C _.....,...__,...,�..� ., ..,,..tee:.,.- ..,, :roc.-�.rra;.•ar:*w-•�:• a City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER , _ 4"ruck TR A&I , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at I Az �- ON ONb - S`- NV- , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor. under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date .Z -7 1!-R 0 -1b